How to Stay Young at Heart and Keep Your Blood Pressure Low
Of all the causes of atrial fibrillation that I see in my clinic each week, high blood pressure, obesity, and sleep apnea are the most common. I am seeing high blood pressure and sleep apnea now in very young patients. As a consequence, I also see atrial fibrillation in very young patients.
For example, a few weeks ago I met with a person who developed high blood pressure and sleep apnea in his teens and atrial fibrillation in his very early twenties. Most of the time, I talk about the importance of treating and preventing the progression of all the problems. When it comes to high blood pressure in young people, I very often receive a response such as, “Give me six months to see what I can do, to get my life in order.”
Unfortunately, in the vast majority of people I see six months later, the blood pressure remains high and the other health problems also remain. At that appointment I don’t ask why they did not do anything to reduce their blood pressure, but instead we focus on what can be done. With all medical problems, you have to keep a certain level of optimism. Just like diets or efforts to stop addictions, all lifestyle changes can be hard and you’ll often find that there are good times and bad times.
This week, two new studies published in the Journal of the American College of Cardiology drive home the point that high blood pressure is a very serious disease, and preventing it or treating it early is essential.
How Waiting to Treat Blood Pressure Affects Your Future
As our world has become more industrialized, a blood pressure trend has become apparent. As we age our blood pressure increases. In a large American study, called the Framingham Heart Study, systolic blood pressure (the top part of the blood pressure measurement) starts to increase at the age of 30 and continues throughout life. Diastolic blood pressure (the bottom part of the blood pressure measurement) starts to also increase at 30 through mid-life and then tends to stay the same or decline slightly. This is an important concept to recognize.
Most of the patients I meet and talk to about blood pressure tell me they have never had blood pressure problems. However, the fact that risk goes up each year we age accounts for why blood pressure problems are common as we get older. One important point to make about this observation is it does not necessarily have to happen. In many non-industrialized parts to the world, blood pressure does not rise with age. This is important to recognize because daily choices that stem from where we live and what we do influence our blood pressure over our lifetime.
How Blood Pressure Changes Over the Years
In the first study in the Journal of the American College of Cardiology, Dr. Liu and colleagues from the University of South Carolina looked at blood pressure trajectories in our country. Basically, if you start out with a blood pressure at 30 years of age, what is it likely to be at 70? Then they asked the question, what could be done to lower your trajectory or result in a lower blood pressure when you are older? To answer this question they studied, 13,953 healthy men who participated in preventive medical examinations from 1970 to 2006. In addition to a number of tests, these men underwent treadmill testing to determine their level of fitness level compared to the general population. They were classified as low (less than 33 percentile), moderate (33 to 66 percentile), and high (greater than 66 percentile) fitness levels.
The researchers found that those patients in the high fitness classification had a lower blood pressure to begin with and their trajectory throughout their lifetime was lower. For example, a low-fitness level person had a systolic blood pressure of 110 at age 20 that was projected to be between 130 and 135 at 80. A high-fitness level person who had a systolic blood pressure of 106 at age 20 was projected to have a systolic pressure between 120 and 125 at 80. More importantly, the favorable impact of fitness remained across all body fat percentages, blood sugar and cholesterol levels, and those who drank alcohol. It even held up in those with a strong family history of high blood pressure. For blood pressure, then, it is not all in your genes: Your choices significantly impact your risk.
To answer the first question, if you are not serious about your blood pressure early in life or when you first notice a problem, it will become more difficult to treat later on.
How Does Your Fitness Level Stack Up?
Only about 20 to 30 percent of Americans meet CDC guidelines for aerobic and strength activity. If you are meeting these, you are above the 66th percentile for fitness.
Here are the guidelines for activity:
- Do two hours and 30 minutes of moderate-intensity aerobic activity every week, including two or more days that you work on strength training of the major muscle groups (legs, back, abdomen, chest, shoulders, and arms).
- Or do two hours and 15 minutes of vigorous-intensity aerobic activity every week, including two or more days that you work on strength training of the major muscle groups (legs, back, abdomen, chest, shoulders, and arms).
One recommendation to note is the importance of strength training. Most of my patients start by walking, jogging, or using an elliptical machine. Often this results in a frustrating plateau of success regarding weight loss and blood pressure lowering at some point. Adding strength training can minimize this plateauing effect.
If You Are Older, Should You Cut Down on Exercise?
The CDC guidelines tell us to do exactly the opposite. As people get older there is a greater benefit with more exercise. If you are over 50, consider:
- Five hours of moderate-intensity aerobic activity every week, including two or more days that you work on strength training of the major muscle groups (legs, back, abdomen, chest, shoulders, and arms).
- Or two hours and 30 minutes of vigorous-intensity aerobic activity every week, including two or more days that you work on strength training of the major muscle groups (legs, back, abdomen, chest, shoulders, and arms).
You Can Stay Young at Heart
As we exercise and work our muscles, they become more efficient and strong. They also get bigger and thicker. High blood pressure is a continuous workload on the heart. During 100,000 or more beats per day in most of us, the heart has to work to move the blood forward against blood pressure. Unlike our skeletal muscles in our arms and legs, we don’t want our heart to get thick from working against too much of a load. A thick heart can’t open up quickly to accept returning blood. The faster your heart rate becomes, the less efficient a thick heart performs and you develop early fatigue, shortness of breath, and at times dizziness and edema.
The second study looked at the heart over time, in particular how thick it was and if it had started to stiffen. As the heart thickens and stiffens, the upper heart chambers swell in size. Atrial fibrillation and strokes can develop, as well as heart failure symptoms.
A team led by Dr. Paul Bhella and Benjamin Levine from the University of Texas-Southwestern Medical center studied 102 healthy seniors to look at lifestyle patterns and heart function. They separated these seniors into four groups of lifetime activity:
- sedentary (fewer than two exercise sessions per week)
- casual (two to three exercise sessions per week)
- committed (four to five sessions per week)
- competitive (six to seven exercise sessions per week)
What they found was in those who had developed a lifelong pattern of committed or competitive exercise habits, the heart did not stiffen with age or thicken. The heart remained functionally like it was when they were younger.
Many of my elderly patients say it is difficult to get around and that they are stiffer than they use to be. The good news is that your heart does not have to be.